Citation NR: 9613165	
Decision Date: 05/08/96		Archive Date: 05/21/96
DOCKET NO.  94-31 973	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Columbia, 
South Carolina


THE ISSUE

Entitlement to an increased rating for post traumatic stress 
disorder (PTSD), currently evaluated as 30 percent disabling.


REPRESENTATION

Appellant represented by:	Veterans of Foreign Wars of 
the United States


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Debbie A. Riffe, Associate Counsel



INTRODUCTION

The veteran had active service from July 1966 to June 1968.  
In an August 1992 rating decision of the Columbia, South 
Carolina Regional Office (RO), service connection was granted 
for post traumatic stress disorder (PTSD), and a 30 percent 
evaluation was assigned effective from June 1992.  This 
appeal arises from a February 1994 rating decision of the RO, 
which confirmed the 30 percent evaluation for PTSD.  In 
November 1995, the veteran appeared and testified at a Travel 
Board hearing which was conducted by C.W. Symanski, who is 
the member of the Board of Veterans’ Appeals (Board) 
responsible for making a determination in this case.


CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that the RO erred when it determined 
that his ability to earn a living and make and maintain 
relationships was not sufficiently impaired to warrant an 
increased rating.  He claims that his PTSD symptoms warrant a 
rating increase to 70 percent.  The veteran asserts that 
since 1982, he has been unable to keep a job.  He claims that 
he avoids social interactions, except on a superficial level, 
and is unable to trust anyone.  He states that he has had two 
failed marriages, two five-year relationships, and is 
presently involved in another volatile relationship.  He has 
lost contact with his family.  The veteran claims that his 
life continues to be extremely affected by his Vietnam 
experiences, and that he has nightmares, job “languish,” no 
friends, alienation from family, and volatile intimate 
relationships.  


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1995), has reviewed and considered 
all of the evidence and material of record in the veteran's 
claims file.  Based on its review of the relevant evidence in 
this matter, and for the following reasons and bases, it is 
the decision of the Board that the evidence supports a 70 
percent rating for PTSD.


FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable 
disposition of the veteran’s appeal has been obtained by the 
RO.

2.  The veteran’s service connected PTSD is productive of 
severe social and industrial impairment.


CONCLUSION OF LAW

The veteran’s PTSD is 70 percent disabling, according to 
regulatory criteria.  38 U.S.C.A. §§ 1155, 5107 (West 1991); 
38 C.F.R. Part 4, including §§ 4.1, 4.2, 4.7, 4.10, 4.129, 
4.130, Code 9411 (1995).
 

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board is satisfied that all relevant facts have been 
properly developed, and that no further development is 
required to comply with the duty to assist the appellant 
mandated by 38 U.S.C.A. § 5107(a).

By rating action of August 1992, the veteran was granted 
service connection for PTSD, and assigned a 30 percent 
evaluation under the Diagnostic Code 9411 of the VA’s 
Schedule for Rating Disabilities (38 C.F.R. Part 4), 
effective from June 1992.  The action was based on service 
medical records, VA outpatient treatment records, and a VA 
examination, which verified the veteran’s participation in 
combat operations in Vietnam and showed a current diagnosis 
of and treatment for PTSD.  

In September 1992, the veteran submitted a letter indicating 
that he had not been able to hold a job for over ten years.  
He stated that he has had two wives and numerous girlfriends, 
and that he found himself isolated and alone, even in a 
crowd.  

In February 1994, VA outpatient records of one-to-one 
treatment, dated from July 1993 to January 1994, were 
submitted.  On a July 1993 notation, the veteran reported 
nightmares of being chased and flashbacks.  It was noted that 
the veteran had a severe problem with alienation from people.  
The assessment was PTSD, Vietnam, considerable to severe.  On 
a September 1993 record, the veteran reported continuing 
problems with PTSD symptoms, including frequent social 
withdrawal, depressed anxiety, sleep disturbance, nightmares, 
and more intrusive thoughts of Vietnam.  The assessment was 
PTSD, Vietnam, chronic, considerable to severe.  An October 
1993 record indicates that the veteran avoided television, 
newspapers, and social contact with people for days.  The 
assessment was PTSD, Vietnam, chronic, severe industrial and 
social impairment.  On a December 1993 record, the veteran 
reported that his nightmares and intrusive thoughts were 
worse and that he was unable to keep his business going.  The 
assessment was PTSD, considerable to severe.  A January 1994 
record indicates that the veteran reported continuing 
problems with PTSD symptoms.  He had intrusive thoughts, was 
more depressed, and slept less.  The assessment was PTSD, 
Vietnam, chronic, severe industrial and social impairment.  

On a March 1994 psychiatric evaluation report from Silvia 
Bloch, M.D., the veteran reported having nightmares and 
intrusive memories of Vietnam for years.  He had two failed 
marriages and was socially isolated.  The veteran reported 
that he self-medicated with alcohol and drugs.  It was noted 
that during the interview, the veteran was visibly anxious, 
tense, and had sweaty palms.  The veteran reported that he 
currently could not get along with his girlfriend, and that 
he tried odd jobs such as insurance sales.  He reported that 
he got depressed but did not stay depressed and had never 
been suicidal.  On mental status examination, the veteran was 
alert and oriented times three, and his mood was noted to be 
anxious depressive.  His affect was constricted and his 
thoughts were coherent.  The veteran was not suicidal or 
homicidal, but impulsive and aware of his potential for 
impulsive acting out.  He had fair insight and judgment and 
appeared to be of high average intelligence.  His cognition 
and concentration were impaired.  The diagnoses included 
PTSD, Vietnam related with significant comorbidity.  Dr. 
Bloch noted that the veteran tended to overplay his symptoms 
and that his PTSD required ongoing psychological treatment 
and perhaps psychiatric medication management for concomitant 
symptoms of depression and anxiety.

In May 1994, the veteran submitted with his substantive 
appeal a computer printout report of his Social Security 
employment record, dated from 1978 to 1992.  More than two 
dozen employers are listed on the report.  

In May 1994, the veteran’s representative submitted VA form 
646, accompanied by an undated report from a VA counseling 
psychologist.  The report indicates that the veteran’s PTSD 
was seen as materially contributing to the impairment of his 
employability.  It was noted that the veteran’s productivity 
had been sporadic in spite of his above average ability, 
college training, and experience, and that he currently 
worked in insurance sales.  The report indicates that an 
employment handicap existed, which was not serious at the 
present time, and that an assessment of the veteran’s current 
situation suggested that the achievement of a vocational goal 
under Chapter 31 was reasonably feasible at this time.  

On VA examination in September 1994, the veteran reported 
having held three or four jobs this year, working as a 
satellite television salesman, mortgage salesman, and other 
sales jobs.  The veteran complained that he had trouble 
getting along with authority and people, which was manifested 
by difficulty in getting close to people and having a bad 
temper.  He reported nightmares two or three times a week, in 
which he was chased by people he killed in Vietnam, and 
flashbacks which were greater than they were ten years ago.  
The veteran had a consistent problem with alcohol.  He 
indicated that he tried to keep himself busy all day, running 
an office or working out; otherwise, he drank heavily and 
became depressed.  On mental status examination, the veteran 
was pleasant and cooperative, and he appeared somewhat 
anxious, especially when talking about Vietnam or his 
symptoms.  He denied a thinking disorder and hallucinations.  
There was no evidence of delusions, and his judgment and 
insight were good.  The impression included PTSD (Axis I).  
The examiner noted that PTSD clearly interfered with his 
relationships; that he had almost no friends at the time; 
that he could not get along with relatives; that his symptoms 
affected his relationships and ability to hold a job; that he 
self-medicated with alcohol; that he was considered 
moderately disabled from PTSD; and that he was capable of 
managing his own funds.

At a Travel Board hearing in November 1995, the veteran’s 
representative indicated that the veteran had about 30 
different jobs over the past 10 to 12 years and that the 
medical evidence of record showed that the veteran’s PTSD was 
more severe than his present 30 percent evaluation.  The 
veteran testified that he had nightmares, difficulty 
sleeping, and a short temper; that he was not employed by 
anyone because he worked as a independent contractor, “kind 
of” in the mortgage business; that the number of hours he 
worked varied; that his PTSD symptoms affected his abilities 
to do any type of work because he did not like authority; 
that following service he worked himself up to a corporate 
personnel manager, a position he held for 10 years until 1981 
or 1982; that since 1982 he had not worked a year for any one 
company; that he currently experienced “generic” nightmares 
and sleeplessness, and was impatient with people and got 
angry; that he had flashbacks which manifested “in the form 
of anger and anxiety and a sort of a lashing out type of 
thing of whoever is around me”; that his thoughts 
periodically went back to his days in the service; that he 
had a good relationship with his children; that he was fairly 
isolated; and that his PTSD had “ruined” him economically.

At the Travel Board hearing, the veteran submitted a letter 
from VA clinical psychologist, Colin Doyle, Ph.D., dated in 
October 1995.  The letter indicated that he had evaluated and 
treated the veteran since July 1993, and that it was his 
opinion that the veteran was severely disabled due to his 
PTSD.  It was noted that the veteran had approximately 10 
different jobs over the last two years and had not been 
successful at any position, despite his intelligence and 
serious attempts.  He noted that the veteran’s PTSD symptoms 
of severe anxiety, intrusive thoughts, poor sleep, 
nightmares, flashbacks, anger, and irritability resulted in 
significant cognitive impairment, which made his attention 
span, comprehension, and short-term memory unreliable and 
unpredictable.  

Under the applicable criteria, disability evaluations are 
determined by the application of a schedule of ratings which 
is based on average impairment of earning capacity.  
38 U.S.C.A. § 1155; 38 C.F.R. Part 4.  Separate diagnostic 
codes identify the various disabilities.  The Department of 
Veterans Affairs (VA) has a duty to acknowledge and consider 
all regulations which are potentially applicable through the 
assertions and issues raised in the record, and to explain 
the reasons and bases for its conclusions.  Schafrath v. 
Derwinski, 1 Vet.App. 589 (1991).  These regulations include, 
but are not limited to, 38 C.F.R. §§ 4.1 and 4.2.  Also, 
38 C.F.R. § 4.10 provides that, in cases of functional 
impairment, evaluations must be based upon lack of usefulness 
of the affected part or systems, and medical examiners must 
furnish, in addition to the etiological, anatomical, 
pathological, laboratory and prognostic data required for 
ordinary medical classification, full description of the 
effects of the disability upon the person’s ordinary 
activity.  These requirements for evaluation of the complete 
medical history of the claimant’s condition operate to 
protect claimants against adverse decisions based upon a 
single, incomplete, or inaccurate report, and to enable the 
VA to make a more precise evaluation of the level of the 
disability and of any changes in the condition.  Schafrath, 1 
Vet.App. at 594.  When there is a question as to which of two 
evaluations shall be applied, the higher evaluation will be 
assigned if the disability picture more nearly approximates 
the criteria required for that rating.  Otherwise, the lower 
rating will be assigned.  38 C.F.R. § 4.7.  

A 50 percent evaluation for PTSD requires that the ability to 
establish or maintain effective or favorable relationships 
with people is considerably impaired and that by reason of 
psychoneurotic symptoms the reliability, flexibility, and 
efficiency levels are so reduced as to result in considerable 
industrial impairment.  A 70 percent evaluation for PTSD 
requires that the ability to establish and maintain effective 
or favorable relationships with people is severely impaired 
and that psychoneurotic symptoms are of such severity and 
persistence that there is severe impairment in the ability to 
obtain or retain employment.  A 100 percent evaluation 
requires that attitudes of all contacts except the most 
intimate are so adversely affected as to result in virtual 
isolation in the community; that there are totally 
incapacitating psychoneurotic symptoms bordering on gross 
repudiation of reality with disturbed thought or behavioral 
processes associated with almost all daily activities such as 
fantasy, confusion, panic, and explosions of aggressive 
energy resulting in profound retreat from mature behavior; 
and that the individual must be demonstrably unable to obtain 
or retain employment.  38 C.F.R. Part 4, Diagnostic Code 
9411.

38 C.F.R. §§ 4.129 and 4.130 provide that social and 
industrial inadaptability are basic criteria for rating 
mental disorders.  Social integration is one of the best 
evidences of mental health and reflects the ability to 
establish (together with the desire to establish) healthy and 
effective interpersonal relationships.  However, in 
evaluating impairment, social inadaptability is to be 
evaluated only as it affects industrial adaptability.  
38 C.F.R. § 4.129.  In evaluating psychiatric disabilities, 
the severity of disability is based upon actual 
symptomatology as it affects social and industrial 
adaptability.  Two of the most important determinants of 
disability are time lost from gainful work and decrease in 
work efficiency.  An emotionally sick veteran with a good 
work record must not be underevaluated, nor must his 
condition be overevaluated on the basis of a poor work record 
not supported by the psychiatric disability picture.  
38 C.F.R. § 4.130.

In this case, the evidence shows that the veteran continues 
to be treated for PTSD symptoms.  The veteran has problems in 
maintaining relationships with others, as evidenced by his 
failed marriages and broken relationships with girlfriends, 
and in retaining a job, as evidenced by his sporadic and 
inconsistent work history.  It was opined several times in VA 
outpatient treatment records from July 1993 to January 1994 
that the veteran’s PTSD was considerable to severe in degree.  
The undated VA report from a counseling psychologist 
submitted in May 1994 indicated that a employment handicap 
existed for the veteran, although not a very serious one.  In 
the September 1994 VA examination, the veteran was considered 
to be moderately disabled from PTSD.  A VA clinical 
psychologist opined in October 1995 that the veteran was 
severely disabled due to his PTSD.  At the hearing in 
November 1995, it was argued that the veteran could not hold 
a steady job, as evidenced by his spotty work history, and 
that PTSD affected his ability to work in any capacity.  The 
veteran testified that he was isolated socially and had 
problems relating with authority.  His work record with 
numerous job changes in recent years tends to support his 
claim.  Clearly, there are varying opinions as to the 
severity of the veteran’s psychiatric disability ranging from 
moderate to severe.  In view of the spotty work record, the 
veteran’s testimony and the assessments of the psychologists 
who are seeing the veteran for treatment, it would appear 
that the evidence is at least in equipoise as to whether the 
psychiatric disability is productive of considerable or 
severe industrial inadaptability.  Giving the benefit of the 
doubt to the veteran, the Board concludes that the veteran’s 
PTSD is productive of severe social and industrial impairment 
under Code 9411.  Thus, a 70 percent evaluation is warranted.  
It is noted that the veteran is engaged in employment 
currently, working as an independent contractor apparently 
selling insurance.  Under such circumstances, not more than 
70 percent would be in order either under the schedular 
standards or under the provisions of 38 C.F.R. § 4.16 (c).


ORDER

An increased rating to 70 percent for PTSD is granted, 
subject to the applicable criteria governing the payment of 
monetary benefits. 



		
	C.W. SYMANSKI
	Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures 
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 
(1994), permits a proceeding instituted before the Board to 
be assigned to an individual member of the Board for a 
determination.  This proceeding has been assigned to an 
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 &  Supp. 1995), a decision of the Board of Veterans' 
Appeals granting less than the complete benefit, or benefits, 
sought on appeal is appealable to the United States Court of 
Veterans Appeals within 120 days from the date of mailing of 
notice of the decision, provided that a Notice of 
Disagreement concerning an issue which was before the Board 
was filed with the agency of original jurisdiction on or 
after November 18, 1988.  Veterans' Judicial Review Act, 
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988).  The 
date which appears on the face of this decision constitutes 
the date of mailing and the copy of this decision which you 
have received is your notice of the action taken on your 
appeal by the Board of Veterans' Appeals.
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